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3.
BACKGROUND
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Initial uses were telephone calls between healthcare providers, patients
and hospitals
With the advancements of technology the practice grew
NASA and the U.S. military have been the most aggressive in the
advancement of the technology
Prison systems use to prevent the cost and dangers of transporting
prisoners
Telepsychology is a huge benefit to rural areas that are unable to attain
round-the-clock psychiatric care for patients
The Telecommunications Act of 1996
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The American Recovery and Reinvestment Act of 2009
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Allows vendors of cable and telephone services to compete in each others’
markets
Requires carriers to offer same rates and services to urban and rural
providers so that it is affordable in all areas
Funding for research, operations and grants in telemedicine, telehealth and
informatics
Australia, Canada, Norway and Sweden are the current leaders in the
use of telehealth, and have already achieved great strides in this area

4.
DRIVING FORCES
SAFETY, ACCESSIBILITY, COST EFFECTIVENESS
Improved access to providers that allows earlier
treatment
 Care and treatment in the patient’s own home and
community
 More expert advice is available
 Convenient follow-up care
 Improved record keeping of vital signs, blood sugar
readings, wound images
 Healthcare provider time saving, allowing more
time for patient care and less time traveling
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6.
EXAMPLES OF TELEHEALTH USES
A consult/exam done by telecommunications

7.
EXAMPLES OF TELEHEALTH USES CONTINUED
An I-phone app that allows reading and reporting of O2 Sat readings

8.
EXAMPLE OF TELERADIOLOGY
Example from Onepacs.com
X-rays, Cat Scans, MRI’s taken at local hospital, images are
transmitted to a radiologist on duty 24 hours a day. The radiologist
types in the results, then e-mails or faxes back to the local hospital.

9.
TELENURSING
Telephone and faxes have been in use for
decades between nurses and other healthcare
providers
 Home visits via telephone and internet visits
allow for more seen patients daily vs. traveling
to homes in person
 Follow up calls from ER visits/Hospital
admissions
 Dial-A-Nurse, nurse helplines
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10.
BENEFITS OF TELEHEALTH
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Continuity of care
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Centralized health records
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Patients living away from major population centers or in economically disadvantaged areas can access care more
readily
May lower costs for healthcare
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Access to care & access to specialists is improved
Removes geographic barriers to care
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Offerings readily available
Higher quality of care
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Experts are readily available
Education of healthcare consumers & professionals
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Cooperation is fostered among interdisciplinary members of the healthcare team
Improved decision making
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The patient is an active participant in videoconferences
Collaboration among healthcare providers
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Patients remain in the same healthcare system
Incorporation of the health consumer as an active member of the health team
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Patients can stay in the community & use their regular healthcare providers
Eliminates travel costs
Patients are seen earlier when they are not ill
Treatment may take place in local hospitals, which are less costly
Improved quality of health records
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The record contains digitalized records of diagnostic tests, biometric measures, photographs, and communication
Hebda & Czar, 2013, p. 510

12.
APPLICATIONS OF TELEHEALTH
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Ambulatory care settings
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Cardiology
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EMTs & nurses at the site of a disaster can consult with physicians about the health needs of victims
Education
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Patients may report blood glucose readings by using the touch-tone telephone
Mobile unit post-disaster care
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Primary physicians may ask specialists to see a patient without the patient waiting for an appointment with the
specialist and traveling to a distant site
Diabetes management
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Research may be conducted on large databases for educational, diagnostic, cost/benefit analysis, and evidencebased practice
Dermatology
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Patients may be seen at home or in outpatient settings by a counselor at another site
Data mining
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ECG strips can be transmitted for interpretation by experts at a regional referral center, and pacemakers can be reset
from a remote location
Counselling
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Patients are connected with automated systems to monitor medication adverse events & medication non-adherence
Clinicians have real-tine information on a patient’s experience with medications
Healthcare professionals in geographically remote areas can attend seminars to update their knowledge without
extensive travel, expense, or time away from home
Emergency care
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Community hospitals can share information with trauma centers so that the centers can better care for patients &
prepare them for transport
Hebda & Czar, 2013, p. 510

13.
APPLICATIONS OF TELEHEALTH
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Fetal monitoring
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Geriatrics
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Palliative and end-of-life services via technology can increase access to services in remote
areas or supplement traditional care
Military
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Once equipment is in the patient’s home, nurses & physicians may evaluate the patient in home
without leaving their offices
Hospice
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Patients receive automated reminders & education feedback regarding hypertension treatment
guidelines
Home care
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Videoconference equipment in the home permits home monitoring of medication administration
for a patient who has memory deficits but who is otherwise able to stay at home
Hypertension management
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Some high-risk antepartum patients can be monitored from home with greater comfort &
decreased expense
Physicians at remote sites can evaluate injured soldiers in the field via the medic’s equipment
Pharmacy
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Data can be accessed at a centralized location
Hebda & Czar, 2013, p. 510

14.
APPLICATIONS OF TELEHEALTH
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Pathology
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Psychiatry
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Social workers can augment services with telehealth home visits
Virtual intensive care units
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School nurses, particularly in remote areas, can quickly consult with other professionals about
problems observed
Social work
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Radiologists can take calls from home and receive images from the hospital
School clinics
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Specialists at major medical centers can evaluate patients in outlying emergency departments,
hospitals, and clinics via teleconferences
Radiology
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The transmission of slide and tissue samples to other sites make it easier to obtain a second
opinion on biopsy findings
Remote monitoring capabilities and teleconferencing allowing experts at medical centers to monitor
patients in distant, rural hospitals, particularly when weather conditions or other factors do not allow
transport
Extended emergency services
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Remote monitoring and teleconferencing support allow emergency care physicians to view and
monitor ambulance patients, supervise EMTs, initiate treatments early and redirect patients to the
most appropriate facilities, such as burn centers or trauma units, without being seen first in the
emergency department
Hebda & Czar, 2013, p. 510

15.
BARRIERS TO TELEHEALTH
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Regulatory barriers
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Lack of reimbursement for consultative services
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Personnel may fear job loss as more patients can be treated at home & hospital units close
Lack of acceptance by healthcare professionals
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Equipment capable of transmitting and receiving diagnostic grade images is still expensive,
although costs are declining
Fear of healthcare system changes
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Most third party payers do not provide reimbursement unless the patient is seen in person
Costs for equipment, network services, and training time
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State laws are either unclear or may forbid practice across state lines
This may stem from liability concerns & discomfort over not seeing a patient face-to-face
Lack of acceptance by users
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This may stem from discomfort with technology, the relationship with the provider, & concerns
over security of information & confidentiality
Hebda & Czar, 2013, p. 516

16.
WHAT WILL WE SEE IN THE FUTURE?
New ways to access healthcare
 New ways to communicate with and monitor
patients
 Improved reimbursements from insurance to
insure the survivability of the programs
 Improved licensure availability and privacy
 Many international and national organizations
(FCC, National Institute for Nursing Research,
etc…) are putting more money and resources into
this area for growth and expansion of these areas
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